Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial

Tylleskär, Thorkild; Jackson, Debra; Méda, Nicolas; Engebretsen, Ingunn Marie S.; Chopra, Mickey; Diallo, Abdoulaye Hama; Doherty, Tanya; Ekström, Eva‐Charlotte; Goga, Ameena; Kankasa, Chipepo; Klungsøyr, Jørn; Lombard, Carl; Nankabirwa, Victoria; Nankunda, Jolly; Perre, Philippe Van de; Sanders, David; Shanmugam, Rebecca; Sommerfelt, Halvor; Wamani, Henry; Tumwine, James K

doi:10.1016/s0140-6736(11)60738-1

Cited by 241 publications

(350 citation statements)

References 29 publications

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“…We used a study tool developed from the WHO guidelines on infant and young child feeding (IYCF) [24] and a study on early initiation of breastfeeding and EBF in Uganda [25]. The questionnaire was translated into the local language Bari , and translated back into English, by a different expert.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey

Tongun

Sebit

Ndeezi

et al. 2018

Global Health Action

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Background: Pre-lacteal feeding (PLF) is a barrier to optimal breastfeeding and increases the risk of diarrhoea and acute respiratory tract infections in infants.The prevalence and predictors of PLF are not well studied in South Sudan. Understanding the predictors of PLF is crucial in designing interventions to increase exclusive breastfeeding (EBF) rates. Objective: To assess the prevalence and factors associated with PLF in Jubek State, South Sudan. Method: This was a community based cross-sectional study of 810 mothers of children under two years of age in Jubek State, South Sudan. Mothers were interviewed in their homes using a semi-structured questionnaire to collect data on PLF, socio-demographic and birth characteristics. Multivariable analysis was used to identify factors independently associated with PLF. Results: A total of 426/810 (53 %), 95% confidence interval (CI) [48 %, 59 %] mothers had given pre-lacteal feeds to their infants. The commonest pre-lacteal feeds included glucose solution (54%), water (26%), and infant formula (14%). Having received antenatal breastfeeding counselling decreased the odds of PLF [adjusted odds ratio (AOR) 0.60; 95% CI (0.43, 0.82)]; while discarding of colostrum increased the use of pre-lacteal feeds [AOR 1.57; 95% CI (1.17, 2.11)]. Conclusion: The prevalence of PLF in South Sudan is high. Predictors of PLF included lack of breastfeeding counselling and discarding of colostrum. Infant feeding counselling should be given to all pregnant women in the health facilities and communities. The counselling should emphasize the health benefits of colostrum and discourage the practice of discarding it.

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Section: Methodsmentioning

confidence: 99%

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey

Tongun

Sebit

Ndeezi

et al. 2018

Global Health Action

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“…The validated questionnaire was developed from two questionnaires; the first was a locally validated questionnaire from a breastfeeding promotion trial conducted in Eastern Uganda [22] and the second was an infant feeding assessment questionnaire developed by the World Health Organization [23]. A language expert translated the questionnaires to the local language and back translated them to ensure proper translation.…”

Section: Methodsmentioning

confidence: 99%

Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda

Mukunya

Tumwine

Nankabirwa

et al. 2017

Global Health Action

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Background: Initiation of breastfeeding later than 1 hour after birth is associated with increased neonatal morbidity and mortality. Objective: To determine the prevalence and factors associated with delayed initiation of breastfeeding. Methods: We conducted a survey in 2016 of 930 children under the age of 2 years in Lira district, northern Uganda. Mothers of the children were interviewed and data was collected on mobile phones using Open Data Kit software (https://opendatakit.org). Multivariable logistic regression was used to determine factors associated with delayed initiation of breastfeeding. Results: Almost half [48.2%, 95% confidence interval (CI) (44.3–52.1)] of the mothers delayed initiation of breastfeeding. Factors significantly associated with delayed initiation of breastfeeding in multivariable analysis included caesarean delivery [Adjusted Odds Ratio (AOR) 11.10 95% CI (3.73–33.04)], discarding initial breast milk [AOR 2.02 95% CI (1.41–2.88)], home delivery [AOR 1.43 95% CI (1.04–1.97)] and mother being responsible for initiating breastfeeding as compared to a health worker or relative [AOR 1.73 95% CI (1.33–2.26)]. Mothers having a secondary education were less likely [AOR 0.54 95% CI (0.30–0.96)] to delay initiation of breastfeeding as compared to those with no education. Conclusion: About half the mothers delayed initiation of breastfeeding until after 1 hour after birth. Programs to promote, protect and support breastfeeding in this post conflict region are urgently needed.

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“…The BFHI is the most widely used system and can achieve high rates of exclusive breast-feeding in hospital, but high rates are not generally sustained once mothers return home (3)(4)(5) . In contrast, trials of lay or peer counsellors have found substantial increases in rates of exclusive breast-feeding during the first 6 months (6)(7)(8)(9)(10)(11)(12)(13)(14) but the sustainability of systems dependent on unpaid counsellors has been questioned (15) . Programmes that are integrated into routine health services may prove more enduring (16) and in India multiple delivery channels have been used, including community health workers, midwives and traditional birth attendants (17) .…”

mentioning

confidence: 99%

“…Programmes that are integrated into routine health services may prove more enduring (16) and in India multiple delivery channels have been used, including community health workers, midwives and traditional birth attendants (17) . Although there are numerous efficacy studies of breastfeeding promotion interventions and some large-scale interventions using project-supported staff (13,18) , there are few studies of the effectiveness of programmes operating at scale within routine health systems (19,20) where impact may be reduced (1) . There is also very little research related to methods of training those delivering breast-feeding promotion interventions (10,21) .…”

mentioning

confidence: 99%

Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil

Coutinho

Lira

Lima

et al. 2013

Public Health Nutr.

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Objective: Breast-feeding counselling has been identified as the intervention with the greatest potential for reducing child deaths, but there is little experience in delivering breast-feeding counselling at scale within routine health systems. The study aim was to compare rates of exclusive breast-feeding associated with a breast-feeding counselling intervention in which community health agents (CHA) received 20 h of training directed at counselling and practical skills with rates pre-intervention when CHA received 4 h of didactic teaching. Design: Cross-sectional surveys of breast-feeding practices were conducted pre-and post-intervention in random samples of 1266 and 1245 infants aged 0-5?9 months, respectively. Setting: Recife, Brazil, with a population of 2 million. Subjects: CHA (n 1449) of Brazil's Family Health Programme were trained to provide breast-feeding counselling at home visits. Results: Rates of exclusive breast-feeding improved when CHA were trained to provide breast-feeding counselling and were significantly higher by 10-13 percentage points at age 3-5?9 months when compared with pre-intervention rates (P , 0?05). Post-intervention point prevalence of exclusive breast-feeding for infants aged ,4 months was 63 % and for those aged ,6 months was 50 %. Conclusions: Multifunctional CHA were able to deliver breast-feeding counselling at scale within a routine health service and this was associated with a significant increase in rates of exclusive breast-feeding. The study reinforces the need to focus training on counselling and practical skills; a key component was an interactive style that utilized the knowledge and experience of CHA. The findings are relevant to the call by international organizations to scale up breast-feeding counselling.

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Exclusive breastfeeding promotion by peer counsellors in sub-Saharan Africa (PROMISE-EBF): a cluster-randomised trial

Cited by 241 publications

References 29 publications

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey

Prevalence and determinants of pre-lacteal feeding in South Sudan: a community-based survey

Factors associated with delayed initiation of breastfeeding: a survey in Northern Uganda

Promotion of exclusive breast-feeding at scale within routine health services: impact of breast-feeding counselling training for community health workers in Recife, Brazil

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